Born at a Checkpoint

For three years now a UK medical journal, the Lancet, has been working with Palestinian health professionals and researchers to document the effects of stressful living – coping with economic difficulties and shortages, restrictions on movement, political tensions and fear of outside attack – and has just published its latest findings.

Restrictions on movement are an everyday irritant in the occupied Palestinian territory (oPt): Apart from tedious and humiliating searches at checkpoints, residents never know for sure how long their journeys will take, or whether, indeed, they can be made at all. But in a medical emergency these restrictions can be a matter of life or death.

Last year the Lancet’s collaborators described vividly the terror of women waiting to give birth during Israeli bombing raids on Gaza in early 2009: They knew they might need urgent medical care at a time when they were trapped in their homes during the attacks. This year another of their researchers has looked at what happens to women already in labour who are caught at oPt checkpoints.

Halla Shoaibi of Ann Arbor University in the USA estimates that in the period she studied (2000-2007) 10 percent of pregnant Palestinian women were delayed at checkpoints while travelling to hospital to give birth. One result has been a dramatic increase in the number of home births, with women preferring to avoid road trips while in labour for fear of not being able to reach the hospital in time.

Their fears are well founded. Ms Shoaibi says 69 babies were born at checkpoints during those seven years. Thirty five babies and five of the mothers died, an outcome which she considers to amount to a crime against humanity.

When the Lancet group held their first meeting in March 2009, Gaza was still reeling from the Israeli attacks known as Operation Cast Lead, which led to the deaths of well over a 1,000 people. In the latest publication, researchers return to that period, with further analysis of survey material about the effects of the attack on the civilian population.

The disruption to normal life was great. Forty-five percent of those surveyed had to leave their homes and move in with other people for at least 24 hours; 48 percent had other people moving in with them; 48 percent of homes were damaged. Nearly everyone had power cuts all or part of the time, and many also suffered disruption to other services – telephone, water supply and rubbish collection.

Psychological Effects

In terms of psychological effects, over 80 percent reported a family member screaming or crying or having nightmares. Loss of appetite was also commonly reported. But although Gaza is a relatively small area, the effects varied considerably according to where the respondents lived, with the governorates of Gaza and North Gaza the most, and Khan Younis and Rafah (near the border with Egypt) the least affected.

Another study looked at the feelings of insecurity which remained, even six months after the end of the attacks. Some of the results might have been expected – women, for instance, felt more nervous and insecure than men. The groups who reported lower levels of insecurity were those who were better educated, and had a better standard of living, and also older people, those over 65.

Not all the studies published are directly linked to the Palestinian political situation; topics include smoking among teenagers, the number of pharmacists working in the territories (rather high, as it turns out) and the use of antibiotics in veterinary medicine.

The Lancet’s editor, Richard Horton, stresses the importance of encouraging academic research into all aspects of health, as part of the process of rebuilding Palestinian society and strengthening its academic institutions.

He says he sees two immediate priorities: “First, while the collaboration between scientists in Gaza and their colleagues in the West Bank is encouraging, even more effort needs to be invested to create productive alliances between Palestinian academic institutions. And second, while there is much strength in public health research, there is a gap in the clinical sciences. More attention needs to be paid to strengthening research in the many excellent clinical facilities in the region.”

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